AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Fathy Abdolmejed, Ophthalmology Department, Tobruk University, Tobruk,
Citation: Abdolmejed F., Almajri K., Ali G., (2020) The serious eye inflammation of post intraocular Avastin injection. J. Archives of Medical Case Reports and Case Study. 3(2); DOI:10.31579/2692-9392/018
Copyright: © 2020 Fathy Abdolmejed, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 26 August 2020 | Accepted: 07 September 2020 | Published: 14 September 2020
Keywords: endophthalmitis; intra vitreal injection; tobruk-derna – Libya
Retrospective statistical study a collection of all patients with post intra vitreal injection (IVI) endophthalmitis in last 10 year period between 2010–2019 in eye department of Tobruk medical center -Tobruk and eye department of Alwahda hospital - Derna. We aim in this study to review the microbiology, clinical characteristics, diagnosis, and management strategies of post-intra vitreal injection endophthalmitis, by comparing our results with the different studies designs and treatment protocols. There were 9 patients of the after intra vitreal injections endophthalmitis cases. The age average is 70 years, 6 cases are females and 3 casees are male, all of them were practice post intravitreal Avastin injection endophthalmitis. There were 8 patients had Diabetes mellitus (DM), 2 patients had cardiovascular disease and 1 patient had hepatitis C as a systemic disease. The most common causative organism after intra vitreous injection endophthalmitis is Coagulase-negative staphylococci (CNS) 100% from the 56% positive causative organisms and 44% are no detected microorganisms, the outcome of cases which managed with pars-plana-vitrectomy (PPV) improved significantly about 60 Letters (> 3 Lines) and cases managed without PPV > 15 Letters (> 3 Lines). The cases of post intraocular endophthalmitis which diagnosed and treated early with PPV give a good result and can save the vision. The cases of acute POE in the first 3 day had significant better function (P value = 0.02).
Conclusion:
The post intraocular endophthalmitis is a serious complication, but if treated early with PPV give a good result and can save the vision.
Endophthalmitis is a severe intraocular inflammation, due to bacterial or fungal infection, including involvement of the vitreous and/or aqueous humors. It can causes permanent damage to retinal photoreceptors that may lead to partial or complete loss of vision, even with intensive medical and surgical management. For that reason, endophthalmitis is an emergency condition. Endophthalmitis can be caused by either exogenous (micro-organisms diffuse inside the eye through surgery or trauma) or endogenous (through blood from inside the body, through infection or sepsis), [Callegan, Engelbert, Parke and Gilmore 2002].
The post intraocular injection is a rare postoperative endophthalmitis. This is 0.03%-0.072% of all cases of anti-endothelial vascular growth factor (VEGF) injection [Hoevenaars et al., 2012; Park, Ramasay, Shaw, Prasad & Ling, 2014]. The most common causative organisms are CNS, Staphylococcus aurous and Streptococci viridians. The post anti VEGF injection endophthalmitis in general has a moderate visual outcome 6/60 [Dhoot, Kunjukuuju, et al 2013, Solborg Bjerrum S, Kiilgaard JF ,et al, 2013].
The most common cases post intra vitreal injection endophthalmitis occur in first (3-4) days after operation. In this type the bacterial endotoxins and other bacterial products appear to cause direct cellular injury or indirectly enhance the inflammatory effect. [Solborg Bjerrum S, Kiilgaard JF, et al. 2013].
After the introduction of bacteria into the posterior segment, endophthalmitis follows one of two following paths: mild inflammation with effective treatment, which lead recovery of infection, or severe inflammation, not controlled with treatment, which lead to vision loss. [Callegan, Engelbert, Parke and Gilmore 2002].
The most common causes of endophthalmitis are from the patient's conjunctival flora, contamination of sterilised instruments, disposable supplies, solutions, surgical field, or the intraocular lens. [Fang, Y. T., Chien 2006]
Most patients with post-operative endophthalmitis complain from pain and visual loss, and present with signs of conjunctival injection, fibrinous exudation, hypopyon and vitritis. [Rudnisky, Wan, et al. 2013]
There are some methods in management of postoperative endophthalmitis, including prophylaxis, medical and surgical.
Prophylaxis: Following are some examples of prophylaxis: Treatment of pre-existing infections: for example: blepharitis, conjunctivitis, of same eye or contralateral eye [Dancer SJ, Stewart M, et al. 2012 ].
Instillation of 5% povidone iodine into the conjunctival fornices, at least 3-5 minutes prior to operations [Ciulla, Starr, Masket 2002, Joseph S Bertino, 2009]. Scrupulous preparation of the surgical site [Schein OD. 2007, Beyea SC . 2004].
Prophylactic antibiotics: Pre-operative topical fluoroquinolone given in regimens 1 hour to 3 days before operation. But in some studies does not appear to protect against POE [Hollands H, Wong J, 2007], while other studies say it is protective if used postoperatively [Rudnisky C, Wan D, 2013], protective patch will be placed over the eye following surgery on the day of surgery [Behrens-Baumann, Frank, Neß, 2010, Wallin et al. 2005].
There are four methods to confirm the diagnosis; [1] taking aqueous samples and vitreous samples. [2] conjunctival swabs [3] ultrasound to confirm the posterior segment involvement in the case of the cloudy anterior segment. [Malhotra, Mandal,et al. 2008]; [4] polymerase chain reaction (PCR), which can detect a small amount of bacterial DNA. [Cornut, Boisset, et al. 2013, Barry, Cordovés, et al. 2013]. The use of this technique is not without disadvantages, as there is a false-positive rate of 5%, due to sample contamination [Beselga, Campos et al. 2013, Zenith, Rose, Chan. 2012].
Medical treatment of POE: The diagnosis of POE should be prompt and treatment must be initiated as early as possible [Yannuzzi, Patel, 2014]. Endophthalmitis cases can be treated successfully if properly managed and useful vision can be retained [Novosad and Callegan 2011].
Topical antibiotics; which are used to protect the wound from infection but have limited benefit [Lundström, Wejde, et al. 2007]. Topical dexamethasone; which can be used initially 2-hourly in the severe cases. Topical mydriatic; which can be used twice daily.
Systemic medication: Systemic antibiotics: although some studies suggested systemic antibiotic treatment had no effect on the course and outcome of endophthalmitis, however, most recent retrospective still advise to use two types of broad spectrum systemic antibiotics to cover both gram positive and gram-negative organisms, the most commonly used antibiotics, for example: vancomycin 2x 1g i.v. to cover gram-positive organisms, and a third-generation cephalosporin (ceftazidime) 3x 2g i.v. to cover gram-negative organisms, [Novosad and Callegan 2011, Bertino, 2009]. In case of alternative clindamycin 3x 600 mg oral plus ciprofloxacin 2x 750 mg oral or 3x 400 mg i.v. [Behrens-Baumann, Frank, 2010].
Systemic steroid must be used in severe cases of endophthalmitis to limit the destructive complications of the inflammatory process, but should excluding fungal infections.
Intravitreal antibiotics and steroids: [Silver standard]; An intra-vitreal injection of antibiotic should be immediately given to decrease the concentration of most organisms and quickly sterilize the eye. [Behrens-Baumann-2011 and Pham 2005].
The most commonly used antibiotics are ceftazidime and vancomycin [Beselga D, Campos A, Castro M, et al. 2013]. Intra-vitreal administration of dexamethasone may block of the immune response, and decrease progressive damage to the intraocular tissues [Rehak. Blatz. Meier 2008].
Surgical treatment: Pars-plana-vitrectomy (PPV) is used for surgical treatment: [Gold Standard]; If a vitreoretinal surgeon and equipped operating room are available. The best method of treatment is immediate PPV, to decrease the chance of bacterial toxins to attack the retinal photoreceptors. Clearing the posterior segment and maintenance of transparency and vitreal diffusion, leading to faster recovery of vision [Behrens-Baumann-2011 and Rehak, Blatz and Meier, 2007].
MATERIALS AND METHODS
Retrospective study done through collection of the data from the Statistic office in Tobruk medical center-Tobruk and Alwahda hospital-Derna. The recorded data included clinical features of the most serious complication (endophthalmitis) of the post intra vitreal Avastin injection; the data was collected are visual acuity at diagnosis, age and sex of the patients, time of the disease, type, type of management. Additionally classified were operations protocol, type of organism that caused the disease, lab findings , systemic and local disease of affected patients, and the outcome for the patient through the VA findings. We depend on Ranges of vision loss and reading performance (Tab. No. 1) to a get the result of improvement of vision cases of post intraocular Avastin injection endophthalmitis (improvement of vision > 3 lines i.e > 15 letters on visual chart considered clinically a significant improvement). Statistical analysis was performed using Microsoft Office Excel program. Nominal and statistical significant variables were analysed using t- test for two samples. P value ≤ 0.05 or level (95%) was considered statistically significant.
Out of the 9 recorded patients of intravitreal injections endophthalmitis cases, there were 8 patients which receive the medication for treatment of diabetic macular edema, one case for treatment of age related macular degeneration AMD. The age average is 70 years, 6 cases were females and 3 cases were male, all of them were practice postoperative endophthalmitis. There were 8 patients had DM, 2 patients had heart disease and 1 patient had hepatitis C as a systemic disease.
There were 8 cases (89%) where complain from pain, redness and blurred of the vision and one case were pain non remarkable. There were 5 cases presented with synechia and hypopion in the anterior chamber and 4 cases without hypopion, all of the cases were with cells in anterior chamber and vitreous. All the cases after intravitreal medication injections where is acute i.e. the endophthalmitis occurs < 28 days, the most is in the first 10 days, and there are (66.7%) of cases occurs at first 3 days.
The most common causative organism after intra vitreous injection endophthalmitis is Coagulase-negative staphylococci (CNS) (100%) from the 56% positive causative organisms and 44% are no detected microorganisms, see the Figure.
There were 6 patients (66.7%) from all cases of after intravitreal injection were presented with near Blindness vision and two cases with sever blurred of vision and one case with mild blurred of vision. There were 7 patients managed with PPV + intra vitreous medication injection with washing the anterior chamber. The Log MAR Loss of Vision average at diagnosis is 1.98 and at discharge (after receive their management) is 1.3, the vision improved significantly after the management about 30 Letters i.e. improved (> 6 Lines). Although the cases which managed with PPV had worser visual acuity at time of diagnosis Log MAR 2.1 they had clinically better outcome after the management Log MAR 1.5 than the cases which managed without PPV (Log MAR at diagnosis 1.7 and 1.3 after the management), i.e. the outcome of cases of PPV improved significantly about 60 Letters (> 10 Lines) and cases managed without PPV >15 Letters (> 3 Lines).
Avastin is anti-vascular endothelial growth factor (anti-VEGF), these therapy has improved the quality of life for many patients with diabetic maculopathy, age-related macular degeneration, and other ocular diseases involving neovascularization and retinal edema. In these pathologies, the inhibition of intraocular VEGF is the only therapy that can preserve vision. [Semeraro et al., 2015].
Adverse events following intravitreal anti-VEGF injections has no relation to underlying ocular disease. The most common complications of intravitreal injection (IVI) are injection site discomfort, subconjunctival hemorrhage, vitreous reflux, transient increased intraocular pressure (IOP) and defect in the vision. The patient may also develop floaters, vitreous or retinal hemorrhage, and retinal detachment. [Frenkel MP, Haji SA & Frenkel RE, 2010]. The most serious complication of intravitreal injection is endophthalmitis and loss of vision. [Aiello et al., 2004].
In post intravitreal medication injection endophthalmitis, 44% of cases had positive organisms, all were Coagulase-negative staphylococci, making the most common causative organism in post- intravitreal medication injection endophthalmitis, was suggested with other studies. (Lyall et al. 2012 and Shah et al. 2011). The all cases of post- intravitreal medication were acute < 28, there were 6 patients (66.7%) occurred as acute endophthalmitis in the first 3 days after the injection. (Hoveenaars 2012 and Shah 2011).
Hoevenaars 2012 and Rudnisky 2013 reported the most cases of post IVI endophthalmitis cases treated with tap and injection of antibiotic. There were 7 patients (55.6%) had managed with PPV and intravitreal injection of antibiotic (vancomycin and dexamethasone), 2 patients had managed with only intravitral injection of antibiotic (vancomycin and dexamethasone) and there are 2 patients which had managed only with conservative treatment.
Peter Barry, Luis Cordovés, et al. 2013 and Zenith H. Y. Wu, Rose P. S. Chan, 2012, which advised immediately PPV make a significant outcome improvement cases of postoperative endophthalmitis, there were 7 patients managed with PPV + intra vitreous medication injection with washing the anterior chamber, the vision improved significantly after the management about 30 Letters i.e. improved (> 3 Lines). Although the cases which managed with PPV had worser visual acuity at time of diagnosis they had clinically better outcome after the management than the cases which managed without PPV, i.e. the outcome of cases of PPV improved significantly about (> 10 Lines) and cases managed without PPV Letters (> 3 Lines).
Although the postoperative endophthalmitis is sight threatening infection and destructive emergency disease, the appropriate prophylaxis is remain the best way of infection prevention. The delayed presentation, inappropriate management procedures, and severity of causative organism may account for the unfavorable visual outcome. In general post intravitreal endophthalmitis cases can be treatable condition especially when had diagnosed and managed early time with intravitreal antibiotics and early pars-plana-vitrectomy. Statistically we consist, the cases of acute intravitreal endophthalmitis in the first 3 day had significant better function outcome (P value = 0.024).
We would like to thank Mr. Hafez E.L Mansour (Lecturer at Tobruck University) for his help with data retrieval and statistical analysis.
CNV : Coagulase-negative-staphylococci
PPV : Pars-plana-vitrectomy
IVI : Intra vitreal injection
VEGF : Vascular endothelial growth factore
DM : Diabetes mellitus
CME : Cystoids macular edema
DMP : Diabetic maculopathy
AMD : Age related maculopathy
VA : Visual acuity
LP : Light perception
M : Hand movement
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
